Mayor-elect Zohran Mamdani is sure to embed “diversity, equity, and inclusion” ideology across New York City. In at least one area, this discriminatory worldview is already doing damage: Gotham’s public hospitals and clinics.
This story gets complicated fast—which is why it has received little attention.
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On October 25, the New England Journal of Medicine reported that NYC Health + Hospitals, which operates more than 70 patient-care facilities across the city, had introduced a supposedly race-neutral formula for determining patient kidney function. This formula helps doctors identify and treat chronic kidney disease and determine patients’ eligibility for life-saving transplants. In short, it gauges patients’ odds of leading a longer life.
As a nephrologist, I’m deeply familiar with kidney-function calculations. For years, I used the formula that NYC H+H is replacing, which adjusted for proven racial differences in muscle mass and the production of the key chemical that influences kidney function. Yet in recent years, under pressure from DEI ideologues, the medical establishment has labeled that longstanding formula “racist.”
This is false. The old formula was based on empirical data. By accurately estimating kidney function, it was explicitly designed to give black patients an equal path to treatment.
But the medical establishment got its way, and in 2023, the National Kidney Foundation and the American Society of Nephrology rolled out a new formula that didn’t include a separate race adjustment. The goal appeared to be to satisfy activists—not to improve care for patients with kidney disease.
The new formula actually leads to discriminatory, race-based care. Studies show that it underestimates kidney function in black patients and overestimates it for white patients. This matters because the formula helps doctors identify when patients need more intensive care. Removing the race adjustment will lead to black patients receiving sooner-than-necessary referrals for kidney care and transplants, while slowing white patients’ access to the same procedures.
This is a clear-cut example of racial reparations masquerading as progress. As biostatistician Paul Williams has shown, if applied nationwide, the new formula would negate 5.51 million nonblack adults’ advanced-kidney-disease diagnoses and reclassify 4.59 million nonblack adults to less-advanced disease stages. Meantime, it would result in 434,000 additional black adults being diagnosed with chronic kidney disease, and 584,000 black adults being shifted to a more advanced disease stage. That’s a huge disconnect, affecting far more nonblack than black patients.
These dramatic shifts aren’t the result of the formula more accurately gauging individuals’ kidney function. They’re the result of an effort to move away from accurate measurement.
As the new formula gets implemented in places like New York City, some people will be pushed into treatment as others head to the back of the line—all based on race. Retroactively applying this new equation nationally could re-list up to 70,000 black patients on transplant waitlists, displacing nonblack candidates and straining an already overburdened system.
This race-based dispensing of medical care has no place in New York City—or in the United States. NYC Health + Hospitals argues that the old formula falsely inflated black patients’ kidney function estimates by up to 21 percent, delaying referrals to nephrologists, arteriovenous fistula placements for dialysis, and transplant evaluations. That’s simply not true. The old formula was accurate; the new formula is not.
The exact consequences for New York City remain to be seen. But it’s certain that some patients will receive preferential treatments based on their skin color, if they haven’t already. The complexity of the issue has made this opaque to most clinicians, to say nothing of the city at large. But make no mistake: this is race-based medicine, and it puts New Yorkers at risk.
Photo by Francois LOCHON/Gamma-Rapho via Getty Images